Provider Demographics
NPI:1902016066
Name:SHALON ALF
Entity Type:Organization
Organization Name:SHALON ALF
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JESUS
Authorized Official - Middle Name:T
Authorized Official - Last Name:MENECES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:786-444-7465
Mailing Address - Street 1:2841 SW 142ND AVE
Mailing Address - Street 2:
Mailing Address - City:MIAMI
Mailing Address - State:FL
Mailing Address - Zip Code:33175-6537
Mailing Address - Country:US
Mailing Address - Phone:786-444-7465
Mailing Address - Fax:
Practice Address - Street 1:7046 SW 103RD PL
Practice Address - Street 2:
Practice Address - City:MIAMI
Practice Address - State:FL
Practice Address - Zip Code:33173-1324
Practice Address - Country:US
Practice Address - Phone:786-444-7465
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-23
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility